title: Disparities in acute stroke severity, outcomes, and care relative to health insurance status.
abstract: BACKGROUND
  To examine the differences in risk factors and length of hospital stay (LOS) between the insured and uninsured stroke patients, identifying the root causes of increasing hospital stay.
  
  
  METHODS
  Retrospective analysis of stroke registry data of acute stroke patients (N = 19,255) was analyzed to compare risk factors, severity, outcome, and LOS by insurance status. Chart review of patients from a comprehensive stroke center (N = 3290) was studied in greater detail for causes of extended length of stay.
  
  
  RESULTS
  The uninsured patients had poorer control of risk factors and statistically significantly (P < .0001) higher initial stroke severity, mortality, and LOS as compared with insured patients (3.8 versus 4.5 days, respectively). The increased length of stay was largely accounted for by the inability to transfer uninsured patients to inpatient rehabilitation settings.
  
  
  CONCLUSIONS
  This study highlights the need for public policies that provide funding for both primary stroke prevention and poststroke rehabilitation.
authors.affiliation: Public Health Program, Edward J. Bloustein School of Planning and Public Policy-Rutgers, The State University of New Jersey, New Brunswick, New Jersey. Electronic address: 87tito@gmail.com.
authors.forename: Tefera
authors.initials: T
authors.lastname: Gezmu
authors.affiliation: Health and Medical Sciences, New Jersey Neuroscience Institute at JFK Medical Center and Seton Hall University, Edison, New Jersey.
authors.forename: Martin S
authors.initials: MS
authors.lastname: Gizzi
authors.affiliation: Health and Medical Sciences, New Jersey Neuroscience Institute at JFK Medical Center and Seton Hall University, Edison, New Jersey.
authors.forename: Jawad F
authors.initials: JF
authors.lastname: Kirmani
authors.affiliation: Health and Medical Sciences, New Jersey Neuroscience Institute at JFK Medical Center and Seton Hall University, Edison, New Jersey.
authors.forename: Dona
authors.initials: D
authors.lastname: Schneider
authors.affiliation: Health and Medical Sciences, New Jersey Neuroscience Institute at JFK Medical Center and Seton Hall University, Edison, New Jersey.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Moussavi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D004185:Disability Evaluation; D005260:Female; D006297:Health Services Accessibility; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D007902:Length of Stay; D008297:Male; D017057:Medically Uninsured; D008875:Middle Aged; D009515:New Jersey / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D010351:Patient Discharge; D010360:Patient Transfer; D015995:Prevalence; D011787:Quality of Health Care; D012042:Registries; D012047:Rehabilitation Centers; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cerebrovascular disease; health services research; insurance status; length of stay; stroke